I was gonna post this along with that article on GP surgeries and CQC inspections.

Long and short:

- not enough money to fund 24/7 consultants
- we would need a massive increase in other staff: porters, HCAs, nurses, radiographers, theatre assistant staff etc
- all this costs money, far more than the £2bn proposed. Realistically, the public can't afford it.


The NHS was set up for routine 9-5 care and 24/7 emergency care. You need something like a 60% increase in funding and staff, as well as an increase in social care.

This looks unrealistic. With most conditions the consultants will prioritise surgery as soon as they can. This may mean switching surgery at the last minute but it can still be cheaper that way without renegotiating the consultants contracts.

Debated about having a new thread but if I did that for every new bit of NHS-related news, it'd swamp the section.

http://www.dailymail.co.uk/news/article ... -sack.html



Subtext: fire all consultants and then rehire them on new contracts. That's what it sounds like to me at least. Big issues:

As I've said above, there's not enough doctors. So if you have a consultant who works Mon-Sun, then you need to give compensatory rest, which means no surgery/clinics/ward rounds the following week. So you'd need more doctors to cover this.


Actually, key scans and tests are done at the weekends. If you have been in an accident and ruptured your internal organs, the surgical team will arrange an urgent CT scan, the senior radiologist on call will come in to supervise the scan and review the images and form a verbal report for the surgical team (and later write the report), and the surgeons will go and operate.


Completely agree with this but no one has looked at why. They've assumed it's down to lack of senior cover but it's much more than that. Look at who gets admitted during a weekday and who gets admitted at a weekend. Those who come in at the weekend are more likely to be poorly - they couldn't wait until the weekday to see a GP or access the appropriate healthcare (eg oncology ward for cancer patient). Hence they're much more likely to be unwell and have a higher risk of mortality.

Because as above, who has surgery at the weekend? Someone with appendicitis can't wait for surgery until Monday - they need it there and then! Any emergency surgery has a higher risk of mortality than any routine surgery.


Only the most junior of doctors may have a few months experience and there's usually a more experienced junior doc (registrar) between the new doctor and the consultant. The idea is that the consultant comes in if needed. You don't need a consultant to write up drug charts - the junior doc can do that and if they have to see a poorly patient and are stuck, they would contact their registrar. The same thing happens during the week!


Not really - most, if not all, hospitals have a consultant on call who will overview all admissions on the post-take round. The maximum a patient waits is 24 hours and this is no different to a normal working day.


Already happens.

And what happens to these patients? There isn't enough slack in the system to cope with just the rise in patients over winter. You need a massive increase in the number of elective beds, and if you're doing more high-risk surgery, you need more beds and personnel in intensive care and high-dependency units.

And as I've said before, you need a massive increase in social care. Lil ol' Mrs Jones who breaks her hip will get operated on within 48 hours. What happens if the consultant says "you're fit for medical discharge" on a Saturday morning? Nothing because there's no routine social services available at the weekends, you need carers and physio etc. The largest bottleneck at the moment is "bed blockers" - people who are fit to be discharged but can't because there aren't the right services in place yet. This needs attention first before you can improve things to streamline everything through.

I saw all this bollocks was going to happen back when I was a medical student and decided to get out of hospital training and go into General Practice. Whilst it isn't quite "out of the pan and into the fire", it's sure as hell as getting close.

Part of the reason why there is insufficient slack in the system is that it is easy to cut and makes savings easier to do.

Social services prefer to keep the elderly in hospitals because it is cheaper for them. They will not do anything until there is actual need. So if a patient is ready to be discharged then that is when they start to do something. When I spent a month in hospital I saw it with so many patients. Their attitude is why install a hand rail when the person might not return home? So until the person is cleared for release they will do nothing. In fact they are pretty good at running around doing nothing. Charging social services a fee for bed blockers is a start but I have seen people deteriorate in hospital while waiting to be discharged to the point where they cannot be discharged, and have to be readmitted. The problem is that to solve this needs money to social services but they are facing big cuts.